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Preparations to Resume Normal Eligibility and Enrollment Operations: Member Toolkit and Resource Information

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Bulletin
Effective Date:

To:
All Providers Participating in the Virginia Medicaid and FAMIS Programs
From:
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to notify providers that DMAS has assembled a toolkit of information and materials to assist Medicaid members as our agency resumes normal eligibility and enrollment operations. Government agencies sometimes refer to this process as “unwinding”, the Federal continuous coverage requirements established in response to COVID-19. While DMAS does not yet know the official date for resuming normal operations, we are preparing Virginians through outreach and communications reminding Medicaid members to ensure their contact information is current if they have moved or updated their mailing address/phone number(s).

DMAS will continue to send additional resources prior to and during the unwinding period. The member toolkit and other resources for members and stakeholders are available on the Cover Virginia/Cubre Virginia websites. Please share this information with Medicaid members and display appropriate materials in your office(s).

If you have any questions or require additional information regarding DMAS’s plans for resuming normal Medicaid enrollment operations or outreach efforts and resources, please visit https://coverva.org/en, https://cubrevirginia.org/es.

 

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PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

www.virginiamedicaid.dmas.virginia.gov

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

KEPRO

Service authorization information for fee-for-service members.

 

https://dmas.kepro.com/

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

http://www.dmas.virginia.gov/#/med4

CCC Plus

http://www.dmas.virginia.gov/#/cccplus

PACE

http://www.dmas.virginia.gov/#/longtermprograms

Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status and service authorizations for fee-for-service members.

www.MagellanHealth.com/Provider

For credentialing and behavioral health service information, visit:

www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or

Call: 1-800-424-4046

Provider HELPLINE

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.

1-804-786-6273

1-800-552-8627

Aetna Better Health of Virginia

www.aetnabetterhealth.com/Virginia

 1-800-279-1878

Anthem HealthKeepers Plus

www.anthem.com/vamedicaid

1-800-901-0020

Molina Complete Care

1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care

1-800-881-2166 www.optimahealth.com/medicaid

United Healthcare

www.Uhccommunityplan.com/VA

and www.myuhc.com/communityplan

1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711), www.virginiapremier.com